known adverse reaction, allergy or hypersensitivity, to alpha 2 agonists

Not nothing by mouth (NPO)

ASA class \>3

Home oxygen therapy \>2LPM by nasal cannula continuous use

Any evidence of nasal mucosal inflammation, irritation, bleeding or ulceration

Pregnancy, or possibility of pregnancy

Coronary heart disease with stable or unstable angina

Baseline heart rate \<55 beats per minute

Bradyarrhythmia, heart block, presence of pacemaker

Congestive Heart Failure or known Cardiomyopathy (Ejection Fraction \<40% by ECHO, MUGA, or myocardial perfusion imaging)

Cor pulmonale

Liver disease (hepatic transaminases \> 2x upper limit of normal, cirrhosis, end stage liver disease)

diagnosis of moderate to severe Obstructive Sleep Apnea

currently enrolled in any other research study involving drugs or devices

Placebo Controlled Evaluation of Sedation and Physiological Response to Intranasal Dexmedetomidine in Severe COPD